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Account Application Form PDF Print E-mail
Tuesday, 04 October 2011 14:26

Your unique reference is: NAC054539

Please quote the above reference in all related correspondence.

Please note: All applicants must confirm that they are ready to place an order for a minimum value of £150, however if you are applying on behalf of a school this threshold may not apply. All applicants must confirm that they have read and agree to the Terms and Conditions

To speak to someone about the account set up process please call 01509 555500

Account Application Form
Company Name: * VAT Number: *
Company Registered Address:
Address (Street): *  
Address (Area): *  
Address (Post Town): *  
Post Code: * Company Reg. Number: *
 
Is there a separate delivery address? yes no
Separate Delivery Address:
Address (Street):  
Address (Area):  
Address (Post Town):  
Post Code:  
 
Is there a separate invoice or statement address? yes no
Separate Invoice / Statement Address:
Address (Street):  
Address (Area):  
Address (Post Town):  
Post Code:  
  
Buyer's Name: * Finance Contact Name: *
Buyer's Phone Number: * Finance Phone Number: *
Buyer's Fax Number: * Finance Fax Number: *
Buyer's Email: * Finance Email: *
 
If your business is associated with another company or group, please provide the name of that company:
 
Business Sector:
       
       
       
       
       
       
 
Estimated annual spend on laboratory products?
Which type of products are applicable to your business?        
Number of Scientists:  
Credit limit required:  
Will any of the products that you buy from Fisher Scientific be intended for export? *
Will the company re-sell any of the products that it buys from Fisher Scientific? *
 
 
Communication Mechanisms:
Add me to mailing list Prefer telephone
Prefer mail Prefer email
Prefer faxNo promotional contact
 
Date: Name of Applicant: *
  Applicant's Phone Number: *
  Applicant's Email: *

Verification
What is the day before saturday: *
 

Last Updated on Thursday, 09 February 2012 16:28